Healthcare Provider Details

I. General information

NPI: 1114313913
Provider Name (Legal Business Name): NHAN-AI TRUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402
US

IV. Provider business mailing address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5074
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7247
  • Fax: 319-368-5973
Mailing address:
  • Phone: 319-369-7247
  • Fax: 319-368-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-10734
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1114313913
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: